Correlation of the grade of hepatic steatosis between controlled attenuation parameter and ultrasound in patients with fatty liver: a multi-center retrospective cohort study

Background/Aims@#The controlled attenuation parameter (CAP), based on transient elastography, is widely used for noninvasive assessment of the degree of hepatic steatosis (HS). We investigated the correlation of the degree HS between CAP and ultrasound (US) in patients with HS. @*Methods@#In total, 986 patients with US-based HS who underwent transient elastography within 1 month were evaluated. The US-based grade of HS was categorized as mild (grade 1), moderate (grade 2), or severe (grade 3). @*Results@#The CAP was significantly correlated with the US-based grade of HS (r = 0.458, p < 0.001). The median CAP value of each US-based HS grade showed a positive correlation with grade (271.1, 303.7, and 326.7 dB/m for grades 1, 2, and 3). In a multivariate analysis, the US-based HS grade, body mass index, serum albumin, alanine aminotransferase, and total cholesterol, and liver stiffness were all significantly correlated with the CAP value (all p < 0.05). The areas under the receiver operating characteristic curves for grade 2 to 3 and grade 3 HS were 0.749 (95% confidence interval [CI], 0.714 to 0.784) and 0.738 (95% CI, 0.704 to 0.772). The optimal cut-off CAP values to maximize the sum of the sensitivity and specificity for grade 2 to 3 and grade 3 HS were 284.5 dB/m (sensitivity 78.6%, specificity 61.7%) and 298.5 dB/m (sensitivity 84.6%, specificity 55.6%). @*Conclusions@#The correlation of the degree of HS between CAP and US was significantly high in patients with HS, and the optimal cut-off CAP values for grade 2 to 3 and grade 3 HS were 284.5 and 298.5 dB/m.

Optimization of exposure parameters and relationship between subjective and technical image quality in cone-beam computed tomography

PURPOSE: This study was performed to investigate the effect of exposure parameters on image quality obtained using a cone-beam computed tomography (CBCT) scanner and the relationship between physical factors and clinical image quality depending on the diagnostic task. MATERIALS AND METHODS: CBCT images of a SedentexCT IQ phantom and a real skull phantom were obtained under different combinations of tube voltage and tube current (Alphard 3030 CBCT scanner, 78–90 kVp and 2–8 mA). The images obtained using a SedentexCT IQ phantom were analyzed technically, and the physical factors of image noise, contrast resolution, spatial resolution, and metal artifacts were measured. The images obtained using a real skull phantom were evaluated for each diagnostic task by 6 oral and maxillofacial radiologists, and each setting was classified as acceptable or unacceptable based on those evaluations. A statistical analysis of the relationships of exposure parameters and physical factors with observer scores was conducted. RESULTS: For periapical diagnosis and implant planning, the tube current of the acceptable images was significantly higher than that of the unacceptable images. Image noise, the contrast-to-noise ratio (CNR), the line pair chart on the Z axis, and modulation transfer function (MTF) values showed statistically significant differences between the acceptable and unacceptable image groups. The cut-off values obtained using receiver operating characteristic curves for CNR and MTF 10 were useful for determining acceptability. CONCLUSION: Tube current had a major influence on clinical image quality. CNR and MTF 10 were useful physical factors that showed significantly associations with clinical image quality.

Internal derangement as a predictor of provoked pain on mouth opening: A magnetic resonance imaging study

PURPOSE: This study investigated the relationship between pain and internal derangement in temporomandibular disorder (TMD) patients using magnetic resonance imaging (MRI). MATERIALS AND METHODS: This study analyzed 356 TMD patients (712 temporomandibular joints [TMJs]). The inclusion criteria were the presence of spontaneous or provoked pain on one or both TMJs and having undergone MRI. The patients with provoked pain were divided into 3 groups: pain on palpation, pain on mouth opening, and pain on mastication. MRI was performed using a 1.5-T scanner. T1- and T2-weighted parasagittal and paracoronal images were obtained. According to the findings on the T1-weighted images, another 3 groups were created based on internal derangement: normal, disc displacement with reduction, and disc displacement without reduction. The MRI findings were independently interpreted by 2 experienced oral and maxillofacial radiologists at 2 different times. Statistical analysis was performed by the chi-square test using SPSS (version 12.0; SPSS Inc., Chicago, IL, USA). RESULTS: Provoked pain on mouth opening was found to be correlated with internal derangement in TMD patients (P .05). CONCLUSION: These results suggest that internal derangement was a significant predictor of provoked pain on mouth opening.

Gardner syndrome associated with multiple osteomas, intestinal polyposis, and epidermoid cysts

Gardner syndrome is known as a variant of familial adenomatous polyposis. This syndrome is characterized by multiple intestinal polyposes, osteomas, and epidermoid cysts. In addition, dental abnormalities include an increased frequency of multiple odontomas, as well as supernumerary and impacted teeth. The authors report the case of a 7-year-old male patient with Gardner syndrome. Radiographic findings revealed multiple osteomas in both sides of the maxilla, multiple diffuse enostoses in both jaws, and a complex odontoma in the left mandibular body. Two years later, multiple epidermoid cysts on the scalp were found. Since this patient was suspected to have Gardner syndrome, the authors recommended gastrointestinal endoscopy to check for intestinal polyposis. Gastrointestinal endoscopic examination revealed multiple polyposes in the upper gastrointestinal tract and fundus of the stomach. As a result, the final diagnosis was Gardner syndrome.

A Case of Severe Peripheral Polyneuropathy Occurring after Entecavir Treatment in a Hepatitis B Patient / 대한소화기학회지

Entecavir (Baraclude®) is an oral antiviral drug used for the treatment of HBV. Entecavir is a reverse transcriptase inhibitor which prevents the HBV from multiplying. Most common adverse reactions caused by entecavir are headache, fatigue, dizziness, and nausea. Until now, there has been no report of peripheral neuropathy as a side effect associated with entecavir treatment. Herein, we report a case of peripheral neuropathy which probably occurred after treatment with entecavir in a hepatitis B patient. The possibility of the occurrence of this side effect should be carefully taken into consideration when a patient takes a high dose of entecavir for a long period of time or has risk factors for neuropathy at the time of initiating entecavir therapy.

Desmoplastic variant of ameloblastoma of the maxilla: A case report

The desmoplastic variant of ameloblastoma is a rare form of ameloblastoma characterized by unique radiographic and histologic features. A 46-year-old female was referred to our hospital, complaining of swelling in the left upper lip area. Radiographic findings revealed an ill-defined multilocular lesion with a large cystic lesion and thick sclerotic trabeculae on the left anterior maxilla. After the patient underwent partial osteotomy, histologic analysis revealed a desmoplastic ameloblastoma with no evidence of a hybrid lesion or cyst formation. The radiographic findings in the present case were different from those described in previous case reports. These findings are of special importance due to the unfamiliar radiographic and histologic features of this lesion.

Clinicopathological Characteristics of Malignant Eyelid Tumor in Korea

PURPOSE: To determine the clinical characteristics of patients with malignant eyelid tumors in Korea. METHODS: We performed a retrospective review of the medical records of 73 patients with malignant eyelid tumors who were histologically diagnosed at Seoul St. Mary's hospital from April 2004 to September, 2012 and followed for 6 months or longer. RESULTS: Of 73 cases, 41 (56.2%) were diagnosed as basal cell carcinoma, 17 (23.3%) as squamous cell carcinoma, 11 (15.1%) as sebaceous gland carcinoma, 3 (4.1%) as malignant melanoma, and 1 (1.4%) as basosquamous cell carcinoma. The mean age at diagnosis was 68.4 +/- 11.5 years. Tumors developed more commonly on the lower lid (54.8%). Most cases were treated by complete resection of tumors and eyelid reconstruction (95.9%). The prognosis of patients with basal cell carcinoma and squamous cell carcinoma was good, while that of the other tumors was relatively poor. CONCLUSIONS: The most common diagnosis was basal cell carcinoma (56.2%). Recurrence after complete surgical excision and reconstruction was uncommon.

Relationship between pain and effusion on magnetic resonance imaging in temporomandibular disorder patients

PURPOSE: This study was performed to find the relationship between pain and joint effusion using magnetic resonance imaging (MRI) in temporomandibular disorder (TMD) patients. MATERIALS AND METHODS: The study subjects included 232 TMD patients. The inclusion criteria in this study were the presence of spontaneous pain or provoked pain on one or both temporomandibular joints (TMJs). The provoked pain was divided into three groups: pain on palpation (G1), pain on mouth opening (G2), and pain on mastication (G3). MRI examinations were performed using a 1.5-T MRI scanner. T1- and T2-weighted images with para-sagittal and para-coronal images were obtained. According to the T2-weighted image findings, the cases of effusions were divided into four groups: normal, mild (E1), moderate (E2), and marked effusion (E3). A statistical analysis was carried out using the chi2 test with SPSS (version 12.0, SPSS Inc., Chicago, IL, USA). RESULTS: Spontaneous pain, provoked pain, and both spontaneous and provoked pain were significantly related to joint effusion in TMD patients (p0.05). CONCLUSION: Spontaneous pain was related to the MRI findings of joint effusion; however, among the various types of provoked pain, pain on palpation of the masticatory muscles and TMJ was not related to the MRI findings of joint effusion. These results suggest that joint effusion has a significant influence on the prediction of TMJ pain.

Relationship between anterior disc displacement with/without reduction and effusion in temporomandibular disorder patients using magnetic resonance imaging

PURPOSE: This study was performed to evaluate the relationship between anterior disc displacement and effusion in temporomandibular disorder (TMD) patients using magnetic resonance imaging (MRI). MATERIALS AND METHODS: The study subjects included 253 TMD patients. MRI examinations were performed using a 1.5 T MRI scanner. T1- and T2-weighted images with para-sagittal and para-coronal images were obtained. According to the MRI findings, temporomandibular joint (TMJ) disc positions were divided into 3 subgroups: normal, anterior disc displacement with reduction (DWR), and anterior disc displacement without reduction (DWOR). The cases of effusion were divided into 4 groups: normal, mild (E1), moderate (E2), and marked effusion (E3). Statistical analysis was made by the Fisher's exact test using SPSS (version 12.0, SPSS Inc., Chicago, IL, USA). RESULTS: The subjects consisted of 62 males and 191 females with a mean age of 28.5 years. Of the 253 patients, T1- and T2-weighted images revealed 34 (13.4%) normal, DWR in 103 (40.7%), and DWOR in 116 (45.9%) on the right side and 37 (14.6%) normal, DWR in 94 (37.2%), and DWOR in 122 (48.2%) joints on the left side. Also, T2-images revealed 82 (32.4%) normal, 78 (30.8%) E1, 51 (20.2%) E2, and 42 (16.6%) E3 joints on the right side and 79 (31.2%) normal, 85 (33.6%) E1, 57 (22.5%) E2, and 32 (12.7%) E3 on the left side. There was no difference between the right and left side. CONCLUSION: Anterior disc displacement was not related to the MRI findings of effusion in TMD patients (P>0.05).

Malignant Melanoma of Unknown Primary Origin Presenting as Cardiac Metastasis

Malignant melanoma has a very high propensity to metastasize to the heart. However, melanoma may sometimes present as a metastatic lesion in the absence of a primary lesion, which are called melanomas of unknown primary origin. We report a case in which a patient presented with a metastatic maligant melanoma in the right atrium with pericardial effusion and without a primary origin.

Prediction of age-related osteoporosis using fractal analysis on panoramic radiographs

PURPOSE: This study was performed to evaluate the trabecular pattern on panoramic radiographs to predict age-related osteoporosis in postmenopausal women. MATERIALS AND METHODS: Thirty-one postmenopausal osteoporotic women and 25 postmenopausal healthy women between the ages of 50 and 88 were enrolled in this study. The bone mineral density (BMD) of the lumbar vertebrae and femur were calculated using dual-energy X-ray absorptiometry (DXA), and panoramic radiographs were obtained. Fractal dimension (FD) was measured using the box counting method from 560 regions of interest (51x51 pixels) in 6 sites on the panoramic radiographs. The relationships between age and BMD and between FD and BMD were assessed, and the intraobserver agreement was determined. RESULTS: There was a significant difference in the FD values between the osteoporotic and normal groups (p<0.05). There was a significant difference in the FD values at three sites in the jaws (p<0.05). Age was significantly correlated with the BMD measurements, with an odds ratio of 1.25. However, the FD values were not significantly correlated with the BMD measurements, with an odds ratio of 0.000. The intraobserver agreement showed relatively higher correlation coefficients at the upper premolar, lower premolar, and lower anterior regions than the other sites. CONCLUSION: Age was an important risk factor for predicting the presence of osteoporosis in postmenopausal women. The lower premolar region was the most appropriate site for evaluating the FD value on panoramic radiographs. However, further investigation might be needed to predict osteoporosis using an FD value on panoramic radiographs.

Fish-Bone Penetration of the Gastrointestinal Tract Extending into the Pancreas: Report of Two Cases / 대한내과학회지

Most ingested foreign bodies pass through the gastrointestinal tract uneventfully within 1 week of ingestion, and so gastrointestinal tract perforation is rare, occurring in less than 1% of patients. The occurrence of a pancreas penetration secondary to foreign-body perforation is even rarer. Here we report two cases of foreign-body penetration of the gastrointestinal tract extending into the pancreas and retroperitoneum. The findings of these cases serve to remind all clinicians that the diagnosis of a foreign-body perforation should always be kept in mind in a patient with abdominal symptoms, and physicians should endeavor to determine the history of ingestion and be aware of foreign bodies in CT scans.

Late Relapse of an Osteosarcoma Presenting as a Gastric Mass / 대한내과학회지

Metastasis of osteosarcoma to the gastrointestinal tract is very rare. However, since the introduction of intensive adjuvant chemotherapy, the number of reported cases of gastrointestinal metastasis has been increasing in patients with osteosarcoma. Only three cases of gastric metastasis have been reported to date, and no case has been reported in Korea. Delayed metastasis long after successful treatment can also occur in osteosarcoma, particularly in patients who receive adjuvant chemotherapy and radical surgery. Hence, the possibility of gastrointestinal metastasis needs to be considered in the differential diagnosis when patients with osteosarcoma present with gastrointestinal symptoms, such as melena or hematochezia, long after successful treatment, including chemotherapy. Here, we report a recurrent osteosarcoma presenting as gastric metastasis in a patient who underwent a radical limb salvage operation followed by adjuvant chemotherapy and who had no evidence of recurrent disease for 11 years.

Detection of Extracellular Enzyme Activities in Ganoderma neo-japonicum

The ability of Ganoderma to produce extracellular enzymes, including beta-glucosidase, cellulase, avicelase, pectinase, xylanase, protease, amylase, and ligninase was tested in chromogenic media. beta-glucosidase showed the highest activity, among the eight tested enzymes. In particular, Ganoderma neo-japonicum showed significantly stronger activity for beta-glucosidase than that of the other enzymes. Two Ganoderma lucidum isolates showed moderate activity for avicelase; however, Ganoderma neo-japonicum showed the strongest activity. Moderate ligninase activity was only observed in Ganoderma neo-japonicum. In contrast, pectinase, amylase, protease, and cellulase were not present in Ganoderma. The results show that the degree of activity of the tested enzymes varied depending on the Ganoderma species tested.

Optimal Media Conditions for the Detection of Extracellular Cellulase Activity in Ganoderma neo-japonicum

To determine the optimal media conditions for the detection of the extracellular cellulase activity in Ganoderma neo-japonicum, we varied three media conditions: dye reagent, pH, and temperature. We evaluated the use of four dyes, Congo red, phenol red, remazol brilliant blue, and trypan blue. To observe the effect of pH on the chromogenic reaction, we tested media ranging from 4.5 to 8.0. To research the effect of temperature on the clear zone and the fungus growing zone, we tested temperatures ranging from 15 to 35degrees C. On the whole, the best protocol called for Ganoderma neo-japonicum transfer onto media containing Congo red with a pH of 7.0, followed by incubation at 25degrees C for 5 days. Our results will be useful to researchers who study extracellular enzyme activity in Ganoderma neo-japonicum.

Nonrotation of the Prearterial Segment of Midgut Presenting as Duodenal Obstruction in a 60-Year-Old Man / 대한소화기학회지

Intestinal malrotation is a developmental anomaly resulting from embryologic failure of fixation and rotation of the gut and predisposed to midgut vovulus and small bowel obstruction. Although various forms of malrotation anomalies in the gut can occur, nonrotation of prearterial segment with the initial symptomatic presentation at advanced age has been rarely reported. Here, we report a case of nonrotation of the prearterial segment of the midgut presenting with duodenal obstruction in a 60-year-old man. To our best knowledge, this is the first case reported about nonrotation of prearterial segment of the midgut in Korea.

A Case of Intramural Duodenal Hematoma Accompanied by Acute Pancreatitis Following Endoscopic Hemostasis for Duodenal Ulcer Bleeding / 대한소화기학회지

Intramural duodenal hematoma is an uncommon condition, which usually develops after blunt abdominal trauma. It is also reported as a complication of anticoagulant therapy, blood dyscrasia, pancreatic disease, and diagnostic and therapeutic endoscopy. The typical clinical pictures of intramural duodenal hematoma consist of upper abdominal pain, vomiting, fever, and hematochezia, and it is rarely accompanied by intestinal obstruction, peritonitis, and pancreatitis as its complication. We report a case of intramural duodenal hematoma extended to peritoneal cavity, and accompanied by acute pancreatitis following therapeutic endoscopy for duodenal ulcer bleeding in a 32-year-old man who was on maintenance of anti-coagulation therapy after valvular heart surgery.

Focal nodular hyperplasia-like nodules in a young man with congenital liver cirrhosis / 대한내과학회지

Focal nodular hyperplasia-like nodules (FNH-like nodules) are hypervascular lesions that occur in the cirrhotic liver. Histologically,they are similar to classical FNH in an otherwise normal liver. Radiologically, FNH-like nodules may mimic hepatocellular carcinoma (HCC), and they have been misdiagnosed as HCC based on radiological findings. Their pathogenesis and etiology are unclear, but they may arise from a local hyperplastic response to vascular alterations like classical FNH. Rarely, these nodules transform into malignant tumors and cause complications. We report the case of a 28-year-old man with multiple FNH-like nodules in congenital liver cirrhosis.

Two cases of sarcomatoid carcinoma of the liver associated with glomerulonephritis / 대한내과학회지

Sarcomatoid carcinoma is a rare malignant neoplasm that may develop in various organs. Hepatocellular carcinoma with sarcomatous changes after anticancer therapy, such as hepatic arterial chemoembolization, has been reported, but primary sarcomatoid carcinoma of the liver is uncommon. Here, we report two cases of primary liver sarcomatoid carcinoma associated with glomerulonephritis in two men (68 and 55 years old, respectively) without any risk factors. Neither man was an alcoholic nor a hepatitis virus carrier, nor did either have a prior medical history of disease. Tumor markers were within normal ranges. In both men, imaging studies revealed a mass in the liver, with metastatic lesions on either the lung or sacrum, respectively. Histopathologic examination of the liver and kidney revealed sarcomatoid carcinoma of the liver and glomerulonephritis.

Black Esophagus Associated with Alcohol Abuse

Black esophagus is a rare condition of the esophagus that manifests as endoscopic findings of black-colored esophageal mucosa, which is usually caused by acute esophageal necrosis. We report a case of alcoholic patient who developed black esophagus. The 85-year-old man was admitted to Severance Hospital due to copious hematemesis over 2 days. Upper gastrointestinal endoscopy showed black-colored mucosa in the distal esophagus. Endoscopic biopsies of the esophagus revealed necrotic tissue, without any viable cells. Follow-up upper gastrointestinal endoscopy performed after supportive care with a proton-pump inhibitor, sucralfate, and total parenteral nutrition resulted in the remarkable healing of the esophageal wall with no complications.